Physical Activity and Exercise in patients with coexisting Chronic Kidney Disease and Peripheral Artery Disease: Time to Bridge the Gap?

Chronic kidney disease (CKD) and peripheral artery disease (PAD) are highly prevalent conditions associated with morbidity, mortality, and healthcare costs, particularly when they coexist. Despite advances in pharmacological and interventional therapies, patients with both CKD and PAD have rapid functional decline, higher hospitalization rates and poor cardiovascular outcomes. In populations with either CKD or PAD alone, exercise training has been shown to improve cardiorespiratory fitness, muscle strength, physical function, and quality of life and is strongly recommended in guidelines. However, evidence for exercise training in patients with overlapping CKD and PAD remains limited with no randomized controlled trials and only a single observational cohort suggesting potential benefits of home-based walking programs on renal and cardiovascular outcomes. This narrative review examines the potential benefits of exercise training as a non-pharmacological approach to addressing this therapeutic gap. An ongoing randomized controlled trial, EXACT-CKDPAD, is expected to provide more definitive evidence in this high-risk population, although further studies will be required to define long-term clinical impact and optimal implementation strategies.